Practice nurse involvement in general practice clinical care: policy and funding issues need resolution

2014 ◽  
Vol 38 (3) ◽  
pp. 301 ◽  
Author(s):  
Hossein Haji Ali Afzali ◽  
Jonathan Karnon ◽  
Justin Beilby ◽  
Jodi Gray ◽  
Christine Holton ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Chronic Conditions ◽  
Practice Nurse ◽  
Clinical Care ◽  
Cost Effective ◽  
Clinical Role ◽  
Practice Nurses ◽  
General Practices ◽  
Diabetes And Obesity

In Australia, primary care-based funding initiatives have been implemented to encourage general practices to employ practice nurses. The aim of this paper is to discuss limitations of the current funding and policy arrangements in enhancing the clinical role of practice nurses in the management of chronic conditions. This paper draws on the results of a real-world economic evaluation, the Primary Care Services Improvement Project (PCSIP). The PCSIP linked routinely collected clinical and resource use data to undertake a risk-adjusted cost-effectiveness analysis of increased practice nurse involvement in clinical-based activities for the management of diabetes and obesity. The findings of the PCSIP suggested that the active involvement of practice nurses in collaborative clinical-based activities is cost-effective, as well as addressing general practice workforce issues. Although primary healthcare organisations (e.g. Medicare Locals) can play a key role in supporting enhanced practice nurse roles, improvements to practice nurse funding models could further encourage more efficient use of an important resource. What is known about the topic? There is evidence that the increased involvement of practice nurses in clinical-based activities in the management of patients with chronic conditions (e.g. diabetes and obesity) is cost-effective. The Australian Government has implemented financial incentives to encourage general practices to recruit nurses and to expand nursing roles within collaborative models of care. There is currently insufficient engagement of practice nurses in clinical care. What does this paper add? This paper summarises evidence regarding the value of an enhanced practice nurse role in Australian general practice, and discusses refinements to current funding arrangements for practice nurses. What are the implications for practitioners? Delegating clinical role (e.g. patient education and monitoring clinical progress) to practice nurses in the management of patients with chronic conditions can improve clinical outcomes without adversely affecting general practice business models.

Behavioural change in primary care professionals undertaking online education in dementia care in general practice

2019 ◽  
Vol 25 (3) ◽  
pp. 244 ◽  
Author(s):  
Michael W. Bentley ◽  
Rohan Kerr ◽  
Margaret Ginger ◽  
Jacob Karagoz
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Online Education ◽  
Behavioural Change ◽  
Dementia Care ◽  
Practice Nurses ◽  
People With Dementia ◽  
General Practices ◽  
Primary Care Professionals ◽  
Systematic Framework

A challenge facing general practice is improving the diagnosis, management and care of people with dementia. Training and education for primary care professionals about knowledge and attitudes about dementia is needed. Online resources can provide educational opportunities for health professionals with limited access to dementia training. An online educational resource (four modules over 3 h) was designed to assist primary care practitioners to develop a systematic framework to identify, diagnose and manage patients with dementia within their practice. Interviews and questionnaires (knowledge, attitudes, confidence and behavioural intentions), with practice nurses and international medical graduates working in general practices, were used to evaluate the resource. Participants’ knowledge, confidence and attitudes about dementia increased after completing the modules. Participants had strong intentions to apply a systematic framework to identify and manage dementia. In post-module interviews, participants reported increased awareness, knowledge and confidence in assessing and managing people with dementia, corroborating the questionnaire results. This project has demonstrated some early changes in clinical behaviour around dementia care in general practice. Promoting the value of applying a systematic framework with colleagues and co-workers could increase awareness of, and participation in, dementia assessment by other primary care professionals within general practices.

Workplace factors: The key to successful and sustained continuation of a general practice-based smoking cessation programme

2005 ◽  
Vol 11 (1) ◽  
pp. 55 ◽  
Author(s):  
S. Pullon ◽  
E. Cornford ◽  
D. McLeod ◽  
K. de Silva ◽  
C. Simpson
Keyword(s):  
Primary Care ◽  
Health Promotion ◽  
General Practice ◽  
Smoking Cessation ◽  
Practice Nurse ◽  
Successful Implementation ◽  
Programme Implementation ◽  
Smoking Cessation Programme ◽  
General Practices ◽  
Workplace Factors

Health promotion activity such as smoking cessation is now expected in primary care settings, including general practice. However, successful implementation and continuation of health promotion programmes is often difficult to achieve in any consistent way across a locality. This study aimed to investigate factors associated with implementation and maintenance difficulties for a smoking cessation programme in primary care, despite the provision of well-received training and support for practice nurses and general practitioners. A descriptive evaluation using numerical data and semi-structured interviews was used for general practices in the Wellington region of New Zealand during 2001-2002. The Can Quit Practice smoking cessation programme was developed and made available to all 114 general practices in the Wellington area. Data were collected and interviews conducted about implementation and ongoing programme delivery. One-third (39/114, 34%) of practices accepted and completed training for at least one staff member, usually a practice nurse. Subsequently, only 44% of practices (17/39) went on to achieve full programme implementation. Key factors precluding implementation included inadequate funding for practice nurse and general practitioner time, high patient workloads, lack of practice nurse autonomy and limited practice-wide commitment to smoking cessation. Unfavourable workplace factors can preclude the successful implementation and maintenance of an effective smoking cessation programme for patients, even when health professionals are aware of the benefits of smoking cessation, recognise the worth of offering such programmes, and receive acceptable training and ongoing support at no cost.

scholarly journals Integrating molecular point-of-care testing for influenza into primary care: a mixed-methods feasibility study

2020 ◽  
Vol 70 (697) ◽  
pp. e555-e562 ◽  
Author(s):  
Simon de Lusignan ◽  
Uy Hoang ◽  
Harshana Liyanage ◽  
Manasa Tripathy ◽  
Ivelina Yonova ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Mixed Methods ◽  
Qualitative Analysis ◽  
Point Of Care ◽  
Clinical Care ◽  
Point Of Care Testing ◽  
Surveillance Network ◽  
The Public ◽  
General Practices

BackgroundMolecular point-of-care testing (POCT) for influenza in primary care could influence clinical care and patient outcomes.AimTo assess the feasibility of incorporating influenza POCT into general practice in England.Design and settingA mixed-methods study conducted in six general practices that had not previously participated in respiratory virology sampling, which are part of the Royal College of General Practitioners Research and Surveillance Centre English sentinel surveillance network, from February 2019 to May 2019.MethodA sociotechnical perspective was adopted using the Public Health England POCT implementation toolkit and business process modelling notation to inform qualitative analysis. Quantitative data were collected about the number of samples taken, their representativeness, and the virology results obtained, comparing them with the rest of the sentinel system over the same weeks.ResultsA total of 312 POCTs were performed; 276 were used for quantitative analysis, of which 60 were positive for influenza and 216 were negative. The average swabbing rate was 0.4 per 1000 population and swab positivity was between 16.7% (n = 14/84) and 41.4% (n = 12/29). Given a positive influenza POCT result, the odds ratio of receiving an antiviral was 14.1 (95% confidence intervals [CI] = 2.9 to 70.0, P<0.001) and of receiving an antibiotic was 0.4 (95% CI = 0.2 to 0.8, P = 0.01), compared with patients with a negative result. Qualitative analysis showed that it was feasible for practices to implement POCT, but there is considerable variation in the processes used.ConclusionTesting for influenza using POCT is feasible in primary care and may improve antimicrobial use. However, further evidence from randomised trials of influenza POCT in general practice is needed.

scholarly journals How many general practice consultations occur in Ireland annually? Cross-sectional data from a survey of general practices

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
C. Collins ◽  
R. Homeniuk
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Practice Nurse ◽  
Quality Care ◽  
Cross Sectional ◽  
Practice Nurses ◽  
Irish College ◽  
General Practices ◽  
Evidence Based Healthcare ◽  
Consultation Time

Abstract Background General practice plays a central role in the Irish health system. This study aimed to determine a baseline estimate of the number of consultations completed in general practice in Ireland annually to facilitate evidence-based healthcare planning. Methods A survey was emailed to all 3378 individual members of the Irish College of General Practitioners in February 2020 asking each practice to report on consultations by general practitioners and practice nurses occurring on the previous day of practice. Results A total of 507 practices responded to the survey, reporting 34,594 general practitioner consultations and 13,161 nurse consultations on one day. Extrapolating this figure nationally, we estimate 21,353,731 GP consultations and 7,749,615 practice nurse consultations occur in Ireland annually. An Irish person visits their GP an estimated 4.34 times a year and the average consultation time is 13.7 min. Conclusions This study shows that over 29.1 million consultations take place in Irish general practice every year. Innovative interventions to increase the capacity of general practice are needed to ensure high-quality care continues to be accessible in Ireland.

scholarly journals Cross sectional study estimating prevalence of heart failure and left ventricular systolic dysfunction in community patients at risk

Heart ◽  
2001 ◽  
Vol 86 (2) ◽  
pp. 172-178 ◽  
Author(s):  
O W Nielsen ◽  
J Hilden ◽  
C T Larsen ◽  
J F Hansen
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
General Practice ◽  
Heart Disease ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Cross Sectional ◽  
General Practices

OBJECTIVETo examine a general practice population to measure the prevalence of signs and symptoms of heart failure (SSHF) and left ventricular systolic dysfunction (LVSD).DESIGNCross sectional screening study in three general practices followed by echocardiography.SETTING AND PATIENTSAll patients ⩾ 50 years in two general practices and ⩾ 40 years in one general practice were screened by case record reviews and questionnaires (n = 2158), to identify subjects with some evidence of heart disease. Among these, subjects were sought who had SSHF (n = 115). Of 357 subjects with evidence of heart disease, 252 were eligible for examination, and 126 underwent further cardiological assessment, including 43 with SSHF.MAIN OUTCOME MEASURESPrevalence of SSHF as defined by a modified Boston index, LVSD defined as an indirectly measured left ventricular ejection fraction ⩽ 0.45, and numbers of subjects needing an echocardiogram to detect one case with LVSD.RESULTSSSHF afflicted 0.5% of quadragenarians and rose to 11.7% of octogenarians. Two thirds were handled in primary care only. At ⩾ 50 years of age 6.4% had SSHF, 2.9% had LVSD, and 1.9% (95% confidence interval 1.3% to 2.5%) had both. To detect one case with LVSD in primary care, 14 patients with evidence of heart disease without SSHF and 5.5 patients with SSHF had to be examined.CONCLUSIONSSHF is extremely prevalent in the community, especially in primary care, but more than two thirds do not have LVSD. The number of subjects with some evidence of heart disease needing an echocardiogram to detect one case of LVSD is 14.

scholarly journals Effectiveness and cost-effectiveness of implementing HIV testing in primary care in East London: protocol for an interrupted time series analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018163 ◽  
Author(s):  
Werner Leber ◽  
Lee Beresford ◽  
Claire Nightingale ◽  
Estela Capelas Barbosa ◽  
Stephen Morris ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
General Practice ◽  
Cost Effectiveness ◽  
Hiv Testing ◽  
Cost Effective ◽  
Interrupted Time Series ◽  
Rapid Hiv Testing ◽  
Post Trial ◽  
Implementation Programme

IntroductionHIV remains underdiagnosed. Guidelines recommend routine HIV testing in primary care, but evidence on implementing testing is lacking. In a previous study, the Rapid HIV Assessment 2 (RHIVA2) cluster randomised controlled trial, we showed that providing training and rapid point-of-care HIV testing at general practice registration (RHIVA2 intervention) in Hackney led to cost-effective, increased and earlier diagnosis of HIV. However, interventions effective in a trial context may be less so when implemented in routine practice. We describe the protocol for an MRC phase IV implementation programme, evaluating the impact of rolling out the RHIVA2 intervention in a post-trial setting. We will use a longitudinal study to examine if the post-trial implementation in Hackney practices is effective and cost-effective, and a cross-sectional study to compare Hackney with two adjacent boroughs providing usual primary care (Newham) and an enhanced service promoting HIV testing in primary care (Tower Hamlets).Methods and analysisService evaluation using interrupted time series and cost-effectiveness analyses. We will include all general practices in three contiguous high HIV prevalence East London boroughs. All adults aged 16 and above registered with the practices will be included. The interventions to be examined are: a post-trial RHIVA2 implementation programme (including practice-based education and training, external quality assurance, incentive payments for rapid HIV testing and incorporation of rapid HIV testing in the sexual health Local Enhanced Service) in Hackney; the general practice sexual health Network Improved Service in Tower Hamlets and usual care in Newham. Coprimary outcomes are rates of HIV testing and new HIV diagnoses.Ethics and disseminationThe chair of the Camden and Islington NHS Research Ethics Committee, London, has endorsed this programme as an evaluation of routine care. Study results will be published in peer-reviewed journals and reported to commissioners.

scholarly journals Datasets collected in general practice: an international comparison using the example of obesity

2018 ◽  
Vol 42 (5) ◽  
pp. 563 ◽  
Author(s):  
Elizabeth Sturgiss ◽  
Kees van Boven
Keyword(s):  
Primary Care ◽  
General Practice ◽  
The Netherlands ◽  
Care Management ◽  
Clinical Care ◽  
International Comparisons ◽  
Health Condition ◽  
Practice Management ◽  
Number Of Patients ◽  
Primary Care Management

International datasets from general practice enable the comparison of how conditions are managed within consultations in different primary healthcare settings. The Australian Bettering the Evaluation and Care of Health (BEACH) and TransHIS from the Netherlands collect in-consultation general practice data that have been used extensively to inform local policy and practice. Obesity is a global health issue with different countries applying varying approaches to management. The objective of the present paper is to compare the primary care management of obesity in Australia and the Netherlands using data collected from consultations. Despite the different prevalence in obesity in the two countries, the number of patients per 1000 patient-years seen with obesity is similar. Patients in Australia with obesity are referred to allied health practitioners more often than Dutch patients. Without quality general practice data, primary care researchers will not have data about the management of conditions within consultations. We use obesity to highlight the strengths of these general practice data sources and to compare their differences. What is known about the topic? Australia had one of the longest-running consecutive datasets about general practice activity in the world, but it has recently lost government funding. The Netherlands has a longitudinal general practice dataset of information collected within consultations since 1985. What does this paper add? We discuss the benefits of general practice-collected data in two countries. Using obesity as a case example, we compare management in general practice between Australia and the Netherlands. This type of analysis should start all international collaborations of primary care management of any health condition. Having a national general practice dataset allows international comparisons of the management of conditions with primary care. Without a current, quality general practice dataset, primary care researchers will not be able to partake in these kinds of comparison studies. What are the implications for practitioners? Australian primary care researchers and clinicians will be at a disadvantage in any international collaboration if they are unable to accurately describe current general practice management. The Netherlands has developed an impressive dataset that requires within-consultation data collection. These datasets allow for person-centred, symptom-specific, longitudinal understanding of general practice management. The possibilities for the quasi-experimental questions that can be answered with such a dataset are limitless. It is only with the ability to answer clinically driven questions that are relevant to primary care that the clinical care of patients can be measured, developed and improved.

scholarly journals Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care: a non-randomised pilot study

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e035087
Author(s):  
Karen Cardwell ◽  
Susan M Smith ◽  
Barbara Clyne ◽  
Laura McCullagh ◽  
Emma Wallace ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Pilot Study ◽  
Medication Review ◽  
Controlled Trial ◽  
Cost Savings ◽  
Practice Team ◽  
Patient Reported ◽  
General Practices ◽  
Medication Changes

ObjectiveLimited evidence suggests integration of pharmacists into the general practice team could improve medicines management for patients, particularly those with multimorbidity and polypharmacy. This study aimed to develop and assess the feasibility of an intervention involving pharmacists, working within general practices, to optimise prescribing in Ireland.DesignNon-randomised pilot study.SettingPrimary care in Ireland.ParticipantsFour general practices, purposively sampled and recruited to reflect a range of practice sizes and demographic profiles.InterventionA pharmacist joined the practice team for 6 months (10 hours/week) and undertook medication reviews (face to face or chart based) for adult patients, provided prescribing advice, supported clinical audits and facilitated practice-based education.Outcome measuresAnonymised practice-level medication (eg, medication changes) and cost data were collected. Patient-reported outcome measure (PROM) data were collected on a subset of older adults (aged ≥65 years) with polypharmacy using patient questionnaires, before and 6 weeks after medication review by the pharmacist.ResultsAcross four practices, 786 patients were identified as having 1521 prescribing issues by the pharmacists. Issues relating to deprescribing medications were addressed most often by the prescriber (59.8%), compared with cost-related issues (5.8%). Medication changes made during the study equated to approximately €57 000 in cost savings assuming they persisted for 12 months. Ninety-six patients aged ≥65 years with polypharmacy were recruited from the four practices for PROM data collection and 64 (66.7%) were followed up. There were no changes in patients’ treatment burden or attitudes to deprescribing following medication review, and there were conflicting changes in patients’ self-reported quality of life.ConclusionsThis non-randomised pilot study demonstrated that an intervention involving pharmacists, working within general practices is feasible to implement and has potential to improve prescribing quality. This study provides rationale to conduct a randomised controlled trial to evaluate the clinical and cost-effectiveness of this intervention.

scholarly journals The cost of immunising at the general practice level

2009 ◽  
Vol 1 (4) ◽  
pp. 286 ◽  
Author(s):  
Nikki Turner ◽  
Paul Rouse ◽  
Stacey Airey ◽  
Helen Petousis-Harris
Keyword(s):  
General Practice ◽  
Cost Allocation ◽  
Cost Model ◽  
Cost Effective ◽  
Fee For Service ◽  
Activity Based Costing ◽  
Childhood Immunisation ◽  
Practice Nurses ◽  
The Mean ◽  
The Cost

INTRODUCTION: Childhood immunisation is one of the most cost-effective activities in health care. However, New Zealand (NZ) has failed to achieve national coverage targets. NZ general practice is the primary site of service delivery and is funded on a fee-for-service basis for delivery of immunisation events. AIM: To determine the average cost to a general practice of delivering childhood immunisation events and to develop a cost model for the typical practice. METHODS: A purposeful selection of 24 diverse practices provided data via questionnaires and a daily log over a week. Costs were modelled using activity-based costing. RESULTS: The mean time spent on an immunisation activity was 23.8 minutes, with 90.7% of all staff time provided by practice nurses. Only 2% of the total time recorded was spent on childhood immunisation opportunistic activities. Practice nurses spent 15% of their total work time on immunisation activity. The mean estimated cost per vaccination event was $25.90; however, there was considerable variability across practices. A ‘typical practice’ model was developed to better understand costs at different levels of activity. CONCLUSIONS: The current level of immunisation benefit subsidy is considerably lower than the cost of a standard vaccination event, although there is wide variability across practices. The costs of delivery exceeding the subsidy may be one reason why there is an apparently small amount of time spent on extra opportunistic activities and a barrier to increasing efforts to raise immunisation rates. KEYWORDS: Immunisation; vaccination; patient care management; cost analysis; cost allocation

scholarly journals The links between the amount of antipsychotic medication prescribed at GP practice level, local demographic factors and medication selection

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S165-S166
Author(s):  
Adrian Heald ◽  
Mike Stedman ◽  
Sanam Farman ◽  
Mark Davies ◽  
Roger Gadsby ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Antipsychotic Medication ◽  
Demographic Factors ◽  
Mental Illnesses ◽  
World Health ◽  
Pharmacological Intervention ◽  
Practice Population ◽  
General Practices ◽  
Antipsychotic Prescribing

AimsTo examine the factors that relate to antipsychotic prescribing in general practices across England and how these relate to cost changes in recent years.BackgroundAntipsychotic medications are the first-line pharmacological intervention for severe mental illnesses(SMI) such as schizophrenia and other psychoses, while also being used to relieve distress and treat neuropsychiatric symptoms in dementia.Since 2014 many antipsychotic agents have moved to generic provision. In 2017_18 supplies of certain generic agents were affected by substantial price increases.MethodThe study examined over time the prescribing volume and prices paid for antipsychotic medication by agent in primary care and considered if price change affected agent selection by prescribers.The NHS in England/Wales publishes each month the prescribing in general practice by BNF code. This was aggregated for the year 2018_19 using Defined Daily doses (DDD) as published by the World Health Organisation Annual Therapeutic Classification (WHO/ATC) and analysed by delivery method and dose level. Cost of each agent year-on-year was determined.Monthly prescribing in primary care was consolidated over 5 years (2013-2018) and DDD amount from WHO/ATC for each agent was used to convert the amount to total DDD/practice.ResultDescriptionIn 2018_19 there were 10,360,865 prescriptions containing 136 million DDD with costs of £110 million at an average cost of £0.81/DDD issued in primary care. We included 5,750 GP Practices with practice population >3000 and with >30 people on their SMI register.Effect of priceIn 2017_18 there was a sharp increase in overall prices and they had not reduced to expected levels by the end of the 2018_19 evaluation year. There was a gradual increase in antipsychotic prescribing over 2013-2019 which was not perturbed by the increase in drug price in 2017/18.RegressionDemographic factorsThe strongest positive relation to increased prescribing of antipsychotics came from higher social disadvantage, higher population density(urban), and comorbidities e.g. chronic obstructive pulmonary disease(COPD). Higher %younger and %older populations, northerliness and non-white (Black and Minority Ethnic (BME)) ethnicity were all independently associated with less antipsychotic prescribing.Prescribing FactorsHigher DDD/general practice population was linked with higher %injectable, higher %liquid, higher doses/prescription and higher %zuclopenthixol. Less DDD/population was linked with general practices using higher %risperidone and higher spending/dose of antipsychotic.ConclusionHigher levels of antipsychotic prescribing are driven by social factors/comorbidities. The link with depot medication prescriptions, alludes to the way that antipsychotics can induce receptor supersensitivity with consequent dose escalation.

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